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Long-term Outcomes in Patients with Chronic Lymphocytic Leukemia Treated with Standard Therapy

Alvarado Ibarra Martha, Mena Zepeda Veronica, Ortiz Zepeda Maricela, Alvarez Vera José, Espitia Ríos Maria, Jiménez Alvarado Rosa and Lopez Hernández Manuel Antonio

The purpose of this study was to report the therapeutic results obtained from prospective protocols at the Hematology Service of our hospital, over the course of this century, before new drugs were used. All patients underwent chemotherapy (only one recent group also received rituximab). All LCL patients taken care of at the Hematology Service of the National Medical Center (CMN) “20 de Noviembre”, ISSSTE. Patients included in this study were diagnosed with LCL and met the following criteria: persistent lymphocytosis above 5 × 109/L, for more than three months; typical lymphocytic morphology, with less than 10% of immature forms; immunophenotype of B strain with CD5, CD19, CD 79a, CD 20, CD22, CD23, CD24, CD25 + low-intensity SmIg; 30%+ lymph cells in the bone marrow. From 2001 to late 2016, 2’857patients were taken care of de novo. Out of these patients, 61 were diagnosed with LCL (2.1%). Twenty-four patients suffered from chronic diseases when LCL was diagnosed; Diabetes Mellitus type 2 in 14 patients; uremia in 4 patients, heart disease in 3 patients; the remaining ones were systemic high blood pressure (2) and rheumatoid arthritis (1). Until 2004, the first-line therapeutic treatment was CL only. CF was applied for the next four years (until 2008). Lastly, CFR is used until 2016. The lack of remission is only noticed when no treatment was administered or CL or CF treatment was administered. The best responses were achieved with CFR (p=0.0001). CL toxicity was found once only (neutropenia). There were two incidents with CF: neutropenia and pancytopenia. CFR was related to two cases of pancytopenia (p= 0.52). In the multivaried analysis, lymphocytic leukocytosis was a negative predictor for SLP and SG and lymph cell count for the bone marrow. Therefore, lymphocytic leukocytosis is the most frequent variable related to the forecast. It seems reasonable that being a benchmark of the neoplastic level it may be used as a reliable indicator. However, this finding has not been consistent, although other authors have reported it. Compared against the new forecasting data and new drugs, the variables herein are applicable only if used as per the treatments used herein. With new drugs, new forecast data are to be used.